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2023 HESI Advanced Pathophysiolog Y Fnp V1 100 Practice Questions And Answers Guaranteed A+: Latest 2023:2024


2023 HESI Advanced Pathophysiolog Y Fnp V1 100 Practice Questions And Answers

2022 - 2023 HESI

Advanced

Pathophysiolog FNP

(Ver. 1 ) 100

Practice Q and A

Included

1. According to Walter B. Cannon, homeostasis is a stable

internal environment achieved through a system of:

A) Interdependentsystem-wide adaptive responses

B) Variable internal and external conditioning factors

C) Coordinated physiologic processes that oppose change

D) Compatibility between cells and the internal environment

Ans: C

Feedback:

Walter B. Cannon identified homeostasis, achieved by a

coordinated physiologic processthat opposes change. Claude Bernard

recognized the importance of compatibility between cells and the

internal environment. Hans Selye identified the general (systemic)

adaptive and interdependent responses to stress. According to Selye,

stressors produce different responses due to the influence of adaptive

internal or external factors (conditioning factors).

2. A child has been experiencing hypoglycemic episodes. “How

does the body know when to secrete insulin and when to stop

secreting it?” The best response by the nurse, explaining the

physiologic background, would be:

A) “The body knows that if the blood glucose level falls, it will

inhibit insulin secretion and release glycogen to release glucose from

the liver.”

B) “It'sjust a big guessing game; first we give sugar like orange

juice, and then we withhold the carbohydrates if the blood glucose

level is too high.”

C) “Your pituitary gland in the brain is the 'master gland,' and it

controls and regulates all the hormones.”

D) “Once the child starts getting confused, the brain will send a

message to the pancreas to stop producing insulin.”

Ans: A

Feedback:

In the negative feedback mechanism that controls blood

glucose levels, an increase in blood glucose stimulates an increase in

insulin, which enhances removal of glucose from the blood. When

glucose has been taken up by cells and blood glucose levels fall, insulin

secretion is inhibited and glucagon and other counterregulatory

mechanisms stimulate release of glucose from the liver, which causes

blood glucose levels to return to normal.

3. A client presents to the emergency department following a

major traffic accident. Though outwardly there are no apparent

physical injuries found, the client is experiencing chest pain and

heightened alertness, which the health care worker attributes to the

first stage of general adaptation syndrome (GAS). The health care

worker concludesthe client is experiencing manifestationsrelated to

the release of:

A) Aldosterone, which interferes with sodium absorption

B) Epinephrine

C) Too little cortisol

D) Thyroid-stimulating hormone

.

Ans: B

Feedback:

The general adaptation syndromes hasthree stages—the first

is alarm (fight or flight); second is resistance (fight); and the third is

exhaustion. The alarm stage is characterized by a generalized

stimulation of the sympathetic nervous system (SNS) and the HPA,

resulting in release of catecholamines and cortisol. Increased insulin

release or TSH release is not part of the GAS.

4. Although stress exposure initiates integrated responses by

multiple systems, the functional results are first manifested as: Select

all that apply.

A) Enhanced respiratory rate/depth

B) Cravingsfor high-carbohydrate foods

C) Increased alertness and focus

D) Increased glucose utilization

E) Increased GI peristalsis

Ans: A, C, D

Feedback:

Exposure to stress activates an immediate response by the

neuroendocrine system that plays a role in most of the responses to

stress and attempts to adapt. Results of the coordinated release of

these neurohormones include mobilization of energy, a sharpened

focus and awareness, increased cerebral blood flow and glucose

utilization, enhanced cardiovascular and respiratory functioning,

redistribution of blood flow to the brain and muscles, modulation of

the immune response, inhibition of reproductive function, and a

decrease in appetite.

5. A client is experiencing significantstress while awaiting the

results of her recent lymph node biopsy. Among the hormonal

contributors to this response is a release of aldosterone, resulting in

which of the following physiologic effects?

A) Decreased release of insulin

B) Increased cardiac contractility

C) Potentiating effects of epinephrine

D) Increased sodium absorption

Ans: D

Feedback:

Mineralocorticoidssuch as aldosterone increase sodium

absorption by the kidneys. Changes in insulin release and cardiac

contractility are mediated by catecholamines, whereas cortisol

potentiates the action of epinephrine.

6. While looking at cancer cells under a microscope, the

instructor asks the students to describe the cells. Which of the student

answers are accurate? Select all that apply.

A) The cells are in different sizes and shapes.

B) The nucleoli are larger than normal.

C) The cells are contact inhibited.

D) The cells do not resemble the tissue of origin.

E) The cells are attached to an extracellular matrix.

Ans: A, B, D

Feedback:

Undifferentiated cancer cells are marked by a number of

morphologic changes. Both the cells and nuclei display variations in

size and shape. Their nuclei are variable in size and bizarre in shape,

their chromatin is coarse and clumped, and their nucleoli are often

considerably larger than normal. The cells of malignant tumors are

characterized by wide changes of parenchymal cell differentiation from

well differentiated to completely undifferentiated. Normal cells that

are grown in culture tend to display a feature called cell density–

dependent inhibition, in which they stop dividing after the cell

population reaches a particular density. This is sometimes referred to

as contact inhibition since cells often stop growing when they come

into contact with each other. In contrast to normal cells, cancer cells

often survive in microenvironments different from those of the normal

cells. They frequently remain viable and multiply without normal

attachments to other cells and the extracellular matrix.

7. The angiogenesis process, which allows tumorsto develop

new blood vessels, is triggered and regulated by tumor-secreted:

A) Procoagulants

B) Growth factors

C) Attachmentfactors

D) Proteolytic enzymes

Ans: B

Feedback:

Many tumors secrete growth factors, which trigger and

regulate the angiogenesis process. Tumor cells express various cell

surface attachment factors, for anchoring. Tumor cells secrete

proteolytic enzymes to degrade the basement membrane and migrate

into surrounding tissue. Cancer cells may produce procoagulant

materials that affect clotting mechanisms.

8. Which of the following processes characterizes an epigenetic

contribution to oncogenesis?

A) A DNA repair mechanism is disrupted.

B) A tumor suppressor gene is present, but it is not expressed.

C) Cellslose their normal contact inhibition.

D) Regulation of apoptosis in impaired, resulting in

accumulation of cancer cells.

Ans: B

Feedback:

Epigenetic mechanisms of cancer growth involve changes in

the patterns of gene expression without a change in the DNA.

Epigenetic mechanisms may “silence” genes,such astumorsuppressor

genes, so that even though the gene is present, it is not expressed and

a cancer-suppressing protein is not made. Disruption of DNA repair

may contribute to cancer, but this process is not particular to

epigenetics. Similarly, loss of contact inhibition and impaired apoptosis

are associated with cancer but are not specific manifestations of

epigenetic mechanisms.

9. An oncology nurse is caring for a client with newly diagnosed

B-cell lymphoma. Extensive blood work has been drawn and sent to

the lab. Results reveal an elevated antiapoptotic protein BCL-2 level.

The client/family asks, “What does this mean?” The health care

provider bases his or her response on the fact that:

A) The client's immune system is trying to kill the cancer cell by

sending this protein to engulf it.

B) This is a good result. Normal cells undergo apoptosis if DNA

is damaged in any way.

C) This means the cancer cells have found a way to survive and

grow even with damaged DNA.

D) The client's body istrying to limit the blood supply to the

cancer cells by producing high levels of this protein.

Ans: C

Feedback:

Alterations in apoptotic and antiapoptotic pathways have

been found in many cancers. One example is the high levels of the

antiapoptotic protein BCL-2 that occur secondary to a chromosomal

translocation in certain B-cell lymphomas. The mitochondrial

membrane is a key regulator of the balance between cell death and

survival. Proteinsin the BCL-2 family reside in the inner mitochondrial

membrane and are either proapoptotic or antiapoptotic. Since

apoptosis is considered a normal cellular response to DNA damage,

loss of normal apoptotic pathways may contribute to cancer by

enabling DNA-damaged cells to survive.

10. A farmer's long-term exposure to pesticides has made the

cellsin his alveoli and bronchial tree susceptible to malignancy. Which

of the following processes has taken place in the farmer's lungs?

A) Promotion

B) Progression

C) Initiation

D) Differentiation

Ans: C

Feedback:

Initiation involvesthe exposure of cellsto appropriate doses

of a carcinogenic agent that makes them susceptible to malignant

transformation, whereas promotion involves the induction of

unregulated accelerated growth in already initiated cells. Progression

isthe later process whereby tumor cells acquire malignant phenotypic

changes, and differentiation is the process of specialization whereby

new cells acquire the structural, microscopic, and functional

characteristics of the cells they replace.

11. Which of the following practitionersis most likely to be of

immediate assistance in the first 24 hours following delivery of an

infant with a cleft lip?

A) Lactation consultant

B) Respiratory therapist

C) Occupational therapist

D) Social worker

Ans: A

Feedback:

Infants with a cleft lip typically have difficulty with feeding,

and the assistance of a lactation consultant may be of help in

establishing feeding patterns. Oxygenation is not a typical problem,

while activities of daily living and assistive devices are not relevant

considerations. While social work is often of assistance when a child is

born with a congenital condition, a cleft lip has fewer implications than

most other inherited disorders.

12. The newborn has been born with distinctive physical features

of trisomy 21, Down syndrome. The mother asks the nurse, “What is

wrong? My baby looks different than his brother.” The nurse assesses

the infant and notes which of the following characteristics that

correlate with trisomy 21? Select all that apply.

A) Upward slanting of eyes

B) Large, protruding ears

C) Large tongue sticking out the mouth

D) Long fingers with extra creases

E) Flat facial profile

Ans: A, C, E

Feedback:

The physical features of a child with Down syndrome are

distinctive, and therefore the condition usually is apparent at birth.

These features include growth failure and a small and rather square

head. There is a flat facial profile, small nose, and somewhat

depressed nasal bridge; upward slanting of the eyes; small, low-set,

and malformed ears; and a large, protruding tongue. The child's hands

usually are short and stubby, with fingers that curl inward, and there

usually is only a single palmar crease (simian crease).

13. A 41-year-old woman has made the recent decision to start a

family and is eager to undergo testing to mitigate the possibility of

having a child with Down syndrome. Which of the following tests is

most likely to provide the data the woman seeks?

A) Genetic testing of the woman

B) Genetic testing of the woman and the father

C) Prenatal blood tests

D) Ultrasonography

Ans: C

Feedback:

Down syndrome is a result of chromosomal abnormality and

is not a single-gene disorder. As a result, genetic testing of the mother

and/or father is not relevant. Ultrasonography does not have

predicative value for Down syndrome, but blood tests such as -

fetoprotein, human chorionic gonadotropin (HCG), unconjugated

estriol, inhibin A, and pregnancy-associated plasma protein A have

helped ascertain the risks.

14. Aneuploidy of the X chromosome can result in a monosomy

or polysomy disorder. The clinical manifestations of a female with

monosomy X include: Select all that apply.

A) A short-stature female individual

B) Difficulty with fine motor skills

C) Large heavy breasts

D) Early-onset (age 8) puberty

E) Nonpitting lymphedema of the feet

Ans: A, B, E

Feedback:

Turner syndrome produces a female individual who is short,

has no secondary sex characteristics, has normal intelligence, and fails

to go through puberty due to an absence of ovaries. Polysomy X is a

XXY male. XXY males have tall slim stature with breast enlargement,

lack ofsperm, and normal intelligence. They may have problems with

visuospatial organization (driving a car, working math problems,

psychomotor skills, etc.). There are variations in the syndrome, with

abnormalities ranging from essentially none to webbing of the neck

with redundant skin folds and nonpitting lymphedema of the hands

and feet.

15. Genetic testing has revealed that a male infant has been born

with an extra X chromosome. What are the most likely implications of

this finding? The child:

A) Is unlikely to survive infancy

B) Islikely to have no manifestations of this chromosomal

abnormality

C) Will have significant neurological and cognitive defects

D) Will be unable to reproduce

Ans: B

Feedback:

An extra X chromosome is associated with Klinefelter

syndrome, but a majority of XXY males do not exhibit visible effects of

this chromosomal abnormality.

16. Although bacterial toxins vary in their activity and effects on

host cells, a small amount of gram-negative bacteria endotoxin:

A) Isreleased during cell growth

B) Inactivates key cellular functions

C) Uses protein to activate enzymes

D) In the cell wall activates inflammation

Ans: D

Feedback:

Endotoxins differfrom exotoxinsin several ways. Endotoxins

are found in the cell wall lipids of gram-negative bacteria and are

potent activators of life-threatening systemic responses such as acute

inflammation with clotting and hypotension. Exotoxins contain

protein, are released during cell growth, inactivate key cell functions,

and have enzymatic activity.

17. A 9-month-old infant has been diagnosed with botulism after

he was fed honey. The child's mother was prompted to seek care

because of this child's sudden onset of neuromuscular deficits, which

were later attributed to the release of substances by Clostridium

botulinum. Which virulence factor contributed to this child's illness?

A) Endotoxins

B) Adhesion factors

C) Exotoxins

D) Evasive factors

Ans: C

Feedback:

Exotoxins are proteinsreleased from the bacterial cell during

growth, as in the case of botulism poisoning. Adhesion factors, evasive

factors, and endotoxins are not evident in this release of botulinum

toxin.

18. While explaining evasive factors by microbes to evade

various components of the host'simmune system,the instructor uses

which of the following examples?

A) H. Pylori being able to survive in an acidic environment

B) Enzymes capable of destroying cell membranes

C) S. aureus ability to immobilize IgG

D) An infectious agent's ability to produce toxins

Ans: A

Feedback:

A number of factors produced by microorganisms enhance

virulence by evading various components of the host's immune

system. H. pylori, the infectious cause of gastritis and gastric ulcers,

produces a urease enzyme on its outer cell wall. The urease converts

gastric urea into ammonia, thus neutralizing the acidic environment of

the stomach and allowing the organism to survive in this hostile

environment. Infectious agents also produce invasive factors that

facilitate the penetration of anatomic barriers and host tissue. Most

invasive factors are enzymes capable of destroying cell membranes

(e.g., phospholipases), connective tissue (e.g., elastases, collagenases),

intercellular matrices (e.g., hyaluronidase), and structural protein

complexes (e.g., proteases). The effects of the pathogen's invasive

factors and toxins, combined with the antimicrobial and inflammatory

substances released by host cells, mediate the tissue damage and

pathophysiology of infectious diseases.

19. A client with a long-standing diagnosis of Crohn disease has

developed a perianal abscess. Which of the following treatments will

this client most likely require?

A) Antiviraltherapy

B) Antibiotic therapy

C) Surgical draining

D) Pressure dressing

Ans: C

Feedback:

Although antibiotics are likely to form a component of this

client's treatment, abscesses most often require surgical draining. A

pressure dressing or the use of antivirals is likely unnecessary.

20. In the usual course (stages) after a pathogen has entered the

host body, the stage when the host initially develops the appearance

of signs/symptoms like a mild fever and body aches is:

A) Incubation

B) Prodromal

C) Acute

D) Convalescence

Ans: B

Feedback:

The prodromalstage followsinoculation (the initialstage)

and is identified by the initial onset ofsymptoms in the host. Tissue

inflammation and damage is evident during the acute (3rd) stage.

Pathogen elimination and containment are characteristics of the

convalescent (4th) period, which follows the acute stage.

21. A client who lives with angina pectoris has taken a sublingual

dose of nitroglycerin to treat the chest pain he experiences while

mowing his lawn. This drug facilitatesrelease of nitric oxide, which will

have what physiologic effect?

A) Smooth muscle relaxation of vessels

B) Decreased heart rate and increased stroke volume

C) Increased preload

D) Reduction of cardiac refractory periods

Ans: A

Feedback:

Nitroglycerin produces its effects by releasing nitric oxide in

vascularsmooth muscle of the target tissues, resulting in relaxation of

this muscle and increased blood flow. This drug does not decrease

heartrate. Because it vasodilates, it decreases preload. Nitroglycerine

does not affect cardiac refractory periods.

22. Following a kitchen accident with a knife, the client's cut has

experienced a decrease in the amount of bleeding and has developed a

clot. The nurse knows this is primarily a result of humoral control of

blood flow with the release of:

A) Histamine

B) Bradykinin

C) Serotonin

D) Prostaglandin E2

Ans: C

Feedback:

Serotonin release causes vasoconstriction of blood vessels

and plays a major role in control of bleeding. Histamine, bradykinin,

and prostaglandin E2 cause vasodilation of blood vessels.

23. A client has had a myocardial infarction (MI) that damaged

the right atrium, which has interfered with the SA node. The

compensatory mechanism, the AV node, becomesthe pacemaker of

the heart and beats how many times/minute?

A) 10 to 20 beats/minute

B) 21 to 30 beats/minute

C) 45 to 50 beats/minute

D) 55 to 60 beats/minute

Ans: C

Feedback:

The AV nodal fibers, when not stimulated, discharge at an

intrinsic rate of 45 to 50 times a minute, and the Purkinje fibers

discharge 15 to 40 times/minute. The SA node hasthe fastest intrinsic

rate of firing (60–100 beats/minute) and normally functions as the

pacemaker of the heart. Should the SA node fail to discharge, the AV

node can assume the pacemaker function of the heart, and the

Purkinje system can assume the pacemaker function of the ventricles

should the AV junction fail to conduct impulses from the atria to the

ventricles.

24. A client asks why he has not had major heart damage since

his cardiac catheterization revealed he has 98% blockage of the right

coronary artery. The nurse's best response is:

A) “You must have been taking a blood thinner for a long time.”

B) “You have small channels between some of your arteries, so

you can get blood from a patent artery to one severely blocked.”

C) “You are just a lucky person since most people would have

had a massive heart attack by now.”

D) “With this amount of blockage, your red blood cells get

through the vessel one-by-one and supply oxygen to the muscle.”

Ans: B

Feedback:

Collateral circulation is a mechanism for the long-term

regulation of local blood flow. In the heart, anastomotic channels exist

between some of the smaller arteries. These channels permit

perfusion of an area by more than one artery. When one artery

becomes occluded, these anastomotic channels increase in size,

allowing blood from a patent artery to perfuse the area supplied by

the occluded vessel. For example, persons with extensive obstruction

of a coronary blood vessel may rely on collateral circulation to meet

the oxygen needs of the myocardial tissue normally supplied by that

vessel. There is no indication that the client is on a blood thinner.

25. The parasympathetic nervous system causes a slowing of the

heart rate by increasing:

A) Norepinephrine

B) Vessel constriction

C) Cardioinhibitory center

D) Smooth muscle tone

Ans: C

Feedback:

The medullary cardiovascular neurons are grouped into three

distinct pools that lead to sympathetic innervation of the heart and

blood vessels and parasympathetic innervation of the heart. The

cardioinhibitory center controls parasympathetic-mediated slowing of

heart rate. The parasympathetic system has little or no control over

blood vessels (constriction, tone). Norepinephrine is the main

neurotransmitter for sympathetic neurons.

26. The shortness of breath and cyanosis that occur in clients

experiencing acute heart failure syndrome are primarily caused by:

Select all that apply.

A) Accumulation of fluid in the alveoli and airways

B) Lung stiffness

C) Worsening renal failure

D) Myocardial muscle necrosis

E) Impaired gas exchange

Ans: A, B, E

Feedback:

Acute pulmonary edema is the most dramatic symptom of

AHFS. It is a life-threatening condition in which capillary fluid moves

into the alveoli. The accumulated fluid in the alveoli and airways

causes lung stiffness, makes lung expansion more difficult, and impairs

the gas exchange function of the lung. With the decreased ability of

the lungs to oxygenate the blood, the hemoglobin leaves the

pulmonary circulation without being fully oxygenated, resulting in

shortness of breath and cyanosis. Worsening renal failure and MI may

cause volume overload but are more likely secondary causes of chronic

heart failure.

27. While in the ICU, a client's status changes. The health care

providers suspect heart failure. Which of the following diagnostic

procedures would give the staff information about pulmonary capillary

pressures, which will lead to the most appropriate interventions?

A) Echocardiography

B) Radionuclide ventriculography

C) Cardiac magnetic resonance imaging

D) Hemodynamic monitoring

Ans: D

Feedback:

Invasive hemodynamic monitoring may be used for

assessment in acute, life-threatening episodes of heart failure. These

monitoring methods include central venous pressure (CVP), pulmonary

artery pressure monitoring, measurements of cardiac output, and

intra-arterial measurements of blood pressure. Echocardiography plays

a key role in assessing ejection fraction, right and left ventricular wall,

wall thickness, ventricular chamber size, valve function, heart defects,

and pericardial disease. Radionuclide ventriculography is

recommended if there is reason to suspect coronary artery disease or

ischemia as the underlying cause for heart failure. Cardiac magnetic

resonance imaging and cardiac computed tomography are used to

document ejection fraction, ventricular preload, and regional wall

motion.

28. A nurse is performing client health education with a 68-yearold man who has recently been diagnosed with heart failure. Which of

the following statements demonstrates an accurate understanding of

his new diagnosis?

A) “I'll be sure to take my beta blocker whenever I feelshort of

breath.”

B) “I'm going to avoid as much physical activity as I can so that I

preserve my strength.”

C) “I know it's healthy to drink a lot of water, and I'm going to

make sure I do this from now on.”

D) “I'm trying to think of ways that I can cut down the amount

of salt that I usually eat.”

Ans: D

Feedback:

Salt and fluid restrictions are indicated for most clients with

heart failure (HF). Beta blockers do not address shortness of breath,

and cardiac medications are not normally taken in response to acute

symptoms. Clients should be encouraged to maintain, and increase,

physical activity within the limits of their condition.

29. A client with a diagnosis of heart failure has returned from a

visit with his primary care provider with a prescription for a change in

his daily medication regimen. Which of the following drugs is likely to

improve the client's cardiac function by increasing the force and

strength of ventricular contractions?

A) A -adrenergic blocker

B) A diuretic

C) A cardiac glycoside

D) An ACE inhibitor

Ans: C

Feedback:

Cardiac glycosides improve cardiac function by increasing the

force and strength of ventricular contractions. -Adrenergic blockers

decrease left ventricular dysfunction associated with activation of the

sympathetic nervous system. ACE inhibitors block the conversion of

angiotensin I to II, whereas diuretics promote the excretion of fluid.

30. A client awaiting a heart transplant is experiencing

decompensation of her left ventricle that will not respond to

medications. The physicians suggest placing the client on a ventricular

assist device (VAD). The client asks what this equipment will do. The

health care providers respond:

A) “Pull your blood from the right side of the heart and run it

through a machine to oxygenate it better, and then return it to your

body.”

B) “Measure the pressures inside your heart continuously to

asses pumping ability of your left ventricle.”

C) “Have a probe at the end of a catheter to obtain

thermodilution measures,so cardiac output can be calculated.”

D) “This device will decrease the workload of the myocardium

while maintaining cardiac output and systemic arterial pressure.”

Ans: D

Feedback:

Refractory heart failure reflects deterioration in cardiac

function that is unresponsive to medical or surgical interventions.

Ventricular assist devices (VADs) are mechanical pumps used to

support ventricular function. VADs are used to decrease the workload

of the myocardium while maintaining cardiac output and systemic

arterial pressure. This decreases the workload on the ventricle and

allows it to rest and recover. The rest of the distractors relate to the

monitoring in an ICU of cardiac functioning. Invasive hemodynamic

monitoring may be used for assessment in acute, life-threatening

episodes of heart failure. With the balloon inflated, the catheter

monitors pulmonary capillary pressures (i.e., pulmonary capillary

wedge pressure or pulmonary artery occlusion pressure), which reflect

pressures from the left ventricle. The pulmonary capillary pressures

provide a means of assessing the pumping ability of the left ventricle.

One type of pulmonary artery catheter is equipped with a thermistor

probe to obtain thermodilution measurements of cardiac output.

31. A car accident client is admitted with a chest tube following

pneumothorax. He also has an elevated blood alcohol level. When the

nurse enters his room,she notes the client is dyspneic,short of breath,

and holding his chest tube in his hand. When the nurse pulls the linens

back, she finds a “sucking” chest wound. After calling a “code blue,”

the next priority intervention would be to:

A) Place the client's meal napkin over the wound

B) Observe and wait for the code blue team to bring equipment

C) Try to calm the patient down by maintaining therapeutic

communication

D) Apply a Vaseline gauze (airtight) dressing over the insertion

site

Ans: D

Feedback:

The client has a medical emergency. Sucking chest wounds,

which allow air to pass in and out of the chest cavity,should be treated

by promptly covering the area with an airtight covering. Chest tubes

are inserted as soon as possible. The other interventions will not help

minimize the amount of air entering the pleural space.

32. A client with a history of heart failure and COPD (caused by

60 pack/year smoking) presents to the clinic with the following

complaints: auscultation of breath sounds reveal absent/diminished

breath sounds in the right lower lobe. Which other manifestations lead

the health care provider to suspect the client may have developed

atelectasis? Select all that apply.

A) Respiratory rate—32; pulse rate—122 beats/minute.

B) “Having a hard time catching my breath.”

C) “Seemslike I'm not making much water (decreased urine

production).”

D) Using accessory muscles to help him breathe.

E) Copious amounts of thick, green sputum.

Ans: A, B, D

Feedback:

Atelectasis is caused most commonly by airway obstruction

rather than a vascular obstruction. The clinical manifestations of

atelectasis include tachypnea (respiratory rate of 32), tachycardia

(pulse rate of 122) dyspnea (hard time catching breath), cyanosis, signs

of hypoxemia, diminished chest expansion, absence of breath sounds,

and intercostal retractions (use of accessory muscles). Both chest

expansion and breath sounds are decreased on the affected side.

There may be intercostalretraction (pulling in of the intercostalspaces)

over the involved area during inspiration. Urine production is not

related to atelectasis. Copious green sputum is associated with

infection.

33. A client has just been admitted to the postsurgical unit

following a below-the-knee amputation. Which of the following

measuresshould her care team prioritize to prevent atelectasis during

the client's immediate recovery?

A) Bedrest and supplementary oxygen by nasal cannula

B) Administration of bronchodilators by nebulizer

C) Deep-breathing exercises and early mobilization

D) Adequate hydration and a high-humidity environment

Ans: C

Feedback:

Coughing and deep breathing and early ambulation decrease

the likelihood of atelectasis developing in surgical clients; bedrest

should be avoided when possible. Oxygen, bronchodilators, hydration,

and high humidity do not prevent atelectasis.

34. Which of the following is most likely to precipitate an

asthmatic attack in a child with a diagnosis of extrinsic, or atopic,

asthma?

A) Pet dander

B) Cold weather

C) Stress

D) Respiratory tractinfections

Ans: A

Feedback:

Extrinsic or atopic asthma is typically initiated by a type I

hypersensitivity reaction induced by exposure to an extrinsic antigen

or allergen such as pet dander. Intrinsic or nonatopic asthma triggers

include respiratory tract infections, exercise, hyperventilation, cold air,

drugs and chemicals, hormonal changes and emotional upsets,

airborne pollutants, and gastroesophageal reflux.

35. Which of the following manifestationstypically accompanies

an asthmatic attack?

A) Decreased residual volume

B) Decreased pulmonary arterial pressure

C) Prolonged inspiration

D) Hyperinflation of the lungs

Ans: D

Feedback:

During a prolonged attack, air becomes trapped behind the

occluded and narrowed airways, causing hyperinflation of the lungs.

This produces an increase in the residual volume of the lungs.

Pulmonary arterial pressure tends to increase and expiration becomes

prolonged.

36. A client has been recently undergone diagnostic testing for

possible Berger disease. The nurse caring for this client would

anticipate the primary clinical manifestations include which of the

following? Select all that apply.

A) Gross hematuria

B) Recent upper respiratory infection

C) Elevated ketone levelsin the urine

D) Fever, chills, and general body aches

Ans: A, B, D

Feedback:

Early in the disease, many people with the disorder have no

obvious symptoms, and the disorder is discovered during screening or

examination for another condition. In others, the disorder presents

with gross hematuria that is preceded by upper respiratory tract

infection, GI tractsymptoms, or flulike illness. The hematuria lasts 2 to

6 days. Elevated ketones are usually associated with acidosis, fasting,

high-protein diet, or diabetes to name a few.

37. A 43-year-old female has recently been diagnosed with

systemic lupus erythematosus (SLE) glomerulonephritis. She has

presented to the out-client department to have a renal biopsy.

Knowing the usual treatment options, the nurse should anticipate

educating the client (who has a positive biopsy result) on which of the

following medications being prescribed? Select all that apply.

A) Lasix, a diuretic

B) Prednisone, a corticosteroid

C) Captopril, an ACE inhibitor

D) Ampicillin, an antibiotic

Ans: B, C

Feedback:

Treatment depends on the extent of glomerular involvement.

Oral corticosteroids and angiotensin-converting enzyme (ACE)

inhibitors are the mainstays of treatment. Diuretics and antibiotics are

not part of the treatment protocol.

38. The most recent assessment of a client with a diagnosis of

type 1 diabetes indicates a heightened risk of diabetic nephropathy.

Which of the following assessment findings is most suggestive of this

increased risk?

A) Microalbuminuria

B) Hematuria

C) Orthostatic hypotension

D) Diabetic retinopathy

Ans: A

Feedback:

The increased glomerular filtration rate (GFR)that occursin

persons with early alterations in renal function is associated with

microalbuminuria, which is an important predictor of future diabetic

nephropathies. Hematuria is not directly suggestive of diabetic

nephropathy, although it is a highly significant assessment finding.

Orthostatic hypotension and diabetic retinopathy are not direct

indicators of diabetic nephropathy.

39. Which of the following diagnostic and assessment results

support the diagnosis of chronic pyelonephritis? Select allthat apply.

A) Polyuria (excess urine output)

B) Nocturia (voiding at night)

C) Bilateral flank pain

D) Blood pressure 140/92

E) Severe pain in upper outer quadrant of the abdomen

Ans: A, B

Feedback:

The symptoms of chronic pyelonephritis often include a

history of recurrent episodes of UTI or acute pyelonephritis. Loss of

tubular function and the ability to concentrate urine give rise to

polyuria and nocturia, and mild proteinuria is common. Severe

hypertension often is a contributing factor in the progress of the

disease. A BP of 140/92 is not considered “severe” hypertension. Flank

and upper outer quadrant pain is usually associated with kidney

stones.

40. An elderly female client has been hospitalized for the

treatment of acute pyelonephritis. Which of the following

characteristics of the client is most likely implicated in the etiology of

her current health problem? The client:

A) Has been diagnosed with type 2 diabetes several years

earlier

B) Takes a diuretic and an ACE inhibitor each day for the

treatment of hypertension

C) Recently had a urinary tractinfection

D) Has peripheral vascular disease

Ans: C

Feedback:

There are two routes by which bacteria can gain access to the

kidney: ascending infection from the lower urinary tract and through

the bloodstream. Ascending infection from the lower urinary tract is

the most important and common route by which bacteria reach the

kidney, resulting in acute pyelonephritis. Diabetes, hypertension

controlled by a diuretic and an ACE inhibitor, and peripheral vascular

disease are not associated with acute pyelonephritis.

41. A client is experiencing bladder hyperactivity. The nurse

should be prepared to educate the client about which of the following

medications that may be injected to help decrease the bladder

hyperactivity?

A) Capsaicin, a specific C-fiber afferent neurotoxin

B) Botulinum toxin type A

C) Oxybutynin, an antimuscarinic agent

D) Urecholine, a cholinergic agonist

Ans: A

Feedback:

Intravesical injection of medications, such as capsaicin and

resiniferatoxin, that are specific C-fiber afferent neurotoxins may be

used to decrease bladder hyperactivity. Botulinum toxin type A is used

to produce paralysis of striated muscles of the externalsphincter.

Oxybutynin, an antimuscarinic agent, will decrease detrusor muscle

tone. Urecholine, a cholinergic agonist, stimulates parasympathetic

receptors to increase bladder tone.

42. A female client asks, “Why do I leak urine every time I cough

or sneeze?” The health care worker's response is based on which

physiologic principle?

A) Involuntary bladder continence during filling

B) A pressure difference between the urethra and bladder

C) When intravesical pressure exceeds maximal urethral closure

pressure

D) A decrease in bladder distensibility

Ans: C

Feedback:

Stress incontinence represents the involuntary loss of urine

that occurs when, in the absence of detrusor muscle action, the

intravesical pressure exceeds the maximum urethral closure pressure.

Stressincontinence, which is a common problem in women of all ages,

occurs as the result of weakness or disruption of pelvic floor muscles,

leading to poorsupport of the vesicourethralsphincters. Except during

the act of micturition, intraurethral pressure is normally greater than

intravesical pressure. Urge incontinence and overactive bladder are

associated with urgency caused by bladder infection or CNS or

myogenic mechanisms. Overflow incontinence is an involuntary loss of

urine that occurs when intravesical pressure exceeds the maximal

urethral pressure because of bladder distention in the absence of

detrusor activity.

43. The nurse is scheduled to teach a client experiencing urinary

incontinence about Kegel exercises. Which of the following descriptors

should the nurse include in this education?

A) “Drink at least two glasses of water and then try to hold it for

at least 3 hours before going to the bathroom.”

B) “Contract and relax the pelvic floor muscles at least 10 times

every hour while awake.”

C) “After you have emptied your bladder, continue sitting on the

commode and try to forcefully expel more urine.”

D) “Try to start and stop urination while sitting in a bathtub full

of warm soapy water.”

Ans: B

Feedback:

Exercises for the pelvic muscles or Kegel exercises involve

repetitive contraction and relaxation of the pelvic floor muscles and

are an essential component of client-dependent behavioral

interventions. None of the other distractors are examples of Kegel

exercises.

44. An elderly client who experiences chronic pain takes opioid

analgesics on a regular basis, a practice that has resulted in frequent

constipation and occasional bowel obstructions. Which of the

following problems may directly result from these gastrointestinal

disorders?

A) Urinary tractinfections

B) Overflow urinary incontinence

C) Bladder cancer

D) Neurogenic bladder

Ans: B

Feedback:

Fecal impaction occurs when a large bolus of stool forms in

the rectum, which can push against the urethra causing obstruction

that results in overflow incontinence. This does not constitute a risk

factor for bladder cancer or neurogenic bladder, and although a

urinary tract infection (UTI) may result, thisis an indirect consequence

of the bowel obstruction.

45. Many factors contribute to the incontinence thatis common

among the elderly. A major factor is increased:

A) Detrusor muscle function

B) Intake of liquids and water

C) Urethral closing pressure

D) Use of multiple medications

Ans: D

Feedback:

Use of multiple medications for other health problems can

affect bladder function, especially diuretics. Drugs such as hypnotics,

tranquilizers, and sedatives can interfere with the conscious inhibition

of voiding, leading to urge incontinence. Detrusor muscle function and

urethral closing pressure are decreased in the elderly, causing

incontinence. Decreased fluid and water intake causes problems of

bowel impaction and urinary tract infection.

46. A major factor in the development of hepatic

encephalopathy is:

A) Hypersplenism

B) High sodium level

C) Neurotoxin accumulation

D) Steroid hormone deficiency

Ans: C

Feedback:

Although the cause of hepatic encephalopathy is unknown,

the accumulation of neurotoxins, which appear in the blood because

the liver has lost its detoxifying capacity, is believed to be a factor. The

liver metabolizesthe steroid hormones; therefore, these hormones are

often elevated in persons with liver failure and cause feminization

(rather than encephalopathy) of male clients. Hypersplenism

associated with liver failure is a factor in the development of anemia,

thrombocytopenia, and leukopenia. Although the mechanisms

responsible for the development of ascites are not completely

understood, several factors seem to contribute to fluid accumulation,

including salt and water retention by the kidney and increase in

capillary pressure due to portal hypertension and obstruction of

venous flow through the liver.

47. Hepatocellular cancer usually has a poor prognosis due in

part to which of the following factors?

A) Surgical options do not exist because removal of all or part of

the liver is a threat to health.

B) Liver cancer typically metastasizes at a much earlierstage

than other cancers.

C) Liver tumors are poorly differentiated due to the low density

of hepatic tissue.

D) The nonspecific symptomatology of liver cancer leads to a

diagnosis at a late stage.

Ans: D

Feedback:

Primary cancers of the liver are often far advanced at the

time of diagnosis. This is partly due to the fact that the manifestations

are often insidious in onset and masked by those related to cirrhosis or

chronic hepatitis. Surgical options exist, and metastasis does not occur

earlier than in other types of cancer, although the liver is a common

site of secondary cancer. Liver tumors do not lack differentiation.

48. An ultrasound (US) of a client with intermittent pain reveals

gallbladder sludge. Which of the following client history items are

likely factors in the US result? Select all that apply.

A) Had lap band surgery 2 years ago and lost 100 pounds

B) Recent pregnancy with a 6-month-old child at home

C) Current prescription for a medicine to lower cholesterol

D) A runner training for a marathon

E) Worksin surgery with long periods ofstanding in one place

Ans: A, B, C

Feedback:

Three factors contribute to the formation of gallstones:

abnormalities in the composition of bile, stasis of bile (rather than

rapid elimination), and inflammation of the gallbladder. The formation

of cholesterol stones is associated with obesity and occurs more

frequently in women, especially women who have had multiple

pregnancies or who are taking oral contraceptives. All of these factors

cause the liver to excrete more cholesterol into the bile. Estrogen

reduces the synthesis of bile acid in women. Gallbladder sludge

(thickened gallbladder mucoprotein with tiny trapped cholesterol

crystals) is thought to be a precursor of gallstones. Sludge frequently

occurs with pregnancy, starvation, and rapid weight loss. Drugs that

lowerserum cholesterol levels,such as clofibrate, also cause increased

cholesterol excretion into the bile.

49. Which of the following factorsis moststrongly associated

with the pathogenesis of gallstones?

A) Excess serum ammonia and urea levels

B) Portal hypertension

C) Abnormalities orstasis of bile

D) High-cholesterol diet

Ans: C

Feedback:

Three factors contribute to the formation of gallstones:

abnormalities in the composition of bile, stasis of bile, and

inflammation of the gallbladder. Portal hypertension, a highcholesterol diet, and excess ammonia and/or urea are not causative

factors of cholelithiasis.

50. Which of the following signs and symptoms is most

suggestive of acute cholecystitis?

A) Upper right quadrant or epigastric pain

B) Fever and sudden abdominal distention

C) Appearance of undigested fat in feces

D) Nausea resulting in greenish vomitus

Ans: A

Feedback:

Persons with acute cholecystitis usually experience an acute

onset of upper right quadrant or epigastric pain. Nausea and vomiting

are also common, although these are not specific to cholecystitis.

Abdominal distention and steatorrhea are not key signs of acute

cholecystitis.

51. The signs and symptoms of abrupt cessation of

pharmacologic glucocorticoids closely resemble those of:

A) Addison disease

B) Cushing disease

C) Cushing syndrome

D) Graves disease

Ans: A

Feedback:

Although the etiology differs, the adrenal cortical

insufficiency resulting from the abrupt cessation of glucocorticoidsis

nearly identical to Addison disease in terms of physiologic effects.

52. Which of the following pathophysiologic phenomena may

result in a diagnosis of Cushing disease?

A) Hypopituitarism

B) Excess ACTH production by a pituitary tumor

C) Autoimmune destruction of the adrenal cortex

D) Malfunction of the HPA system

Ans: B

Feedback:

Three important forms of Cushing syndrome result from

excess glucocorticoid production by the body. One is a pituitary form,

which results from excessive production of ACTH by a tumor of the

pituitary gland. Hypopituitarism and destruction of the adrenal cortex

are associated with Addison disease. Disruption of the HPA system is

not implicated in the etiology of Cushing disease.

53. A lung cancer client with small cell carcinoma may secrete an

excess of which hormone causing an ectopic form of Cushing syndrome

due to a nonpituitary tumor?

A) GH

B) TSH

C) DHEA

D) ACTH

Ans: D

Feedback:

The third form (of Cushing syndrome) is ectopic Cushing

syndrome, caused by a nonpituitary ACTH-secreting tumor. Certain

extra pituitary malignant tumors such as small cell carcinoma of the

lung may secrete ACTH or, rarely, CRH and produce Cushing syndrome.

The adrenalsex hormone dehydroepiandrosterone (DHEA) contributes

to the pubertal growth of body hair, particularly pubic and axillary hair

in women. Thyroid-stimulating hormone (TSH) levels are used to

differentiate between primary and secondary thyroid disorders.

Although secretion of growth hormone (GH) has diurnal variations

over a 24-hour period, with nocturnal sleep bursts occurring 1 to 4

hours after onset of sleep, it is unrelated to ACTH and/or CRH

secretion.

54. The iatrogenic form of Cushing syndrome is caused by:

A) Long-term cortisone therapy

B) Pituitary tumorsecreting ACTH

C) Benign or malignant adrenal tumor

D) Ectopic ACTH-secreting lung tumor

Ans: A

Feedback:

Three important forms of Cushing syndrome result from

excess glucocorticoid production by the body. One is a pituitary form,

which results from excessive production of ACTH by a tumor of the

pituitary gland, called Cushing disease. The second form is the adrenal

form, caused by a benign or malignant adrenal tumor. The third form is

ectopic Cushing syndrome, caused by a nonpituitary ACTH-secreting

tumor, often carcinoma of the lung. Iatrogenic Cushing syndrome

resultsfrom long-term therapy with one of the potent pharmacologic

preparations of glucocorticoids.

55. Which of the following clinical manifestations would support

57. A client with chronic low back pain presents to the clinic. In

addition to a detailed pain assessment, which of the following

questions would be appropriate to ask? Select all that apply.

A) “Do you have trouble making water?”

the medical diagnosis of Cushing syndrome? Select all that apply. B) “Can you financially afford your medicine?”

A) Excessive facial hair growth C) “What kind ofstressors are you experiencing?”

B) Muscle hypertrophy D) “Do you consider yourself a good driver?”

C) Blood glucose level in 200 mg/dL range E) “Are you having trouble sleeping?”

D) “Buffalo hump” on back Ans: B, C, E

E) Blood pressure reading less than 90/70 Feedback:

Ans: A, C, D Unlike acute pain thatserves as a warning system, persistent

Feedback:

The major manifestations of Cushing syndrome represent an

exaggeration of the many actions of cortisol. There is muscle

weakness, and the extremities are thin. Derangements in glucose

metabolism are found in approximately 75% of clients, with clinically

overt diabetes mellitus occurring in approximately 20% of clients. The

glucocorticoids possess mineralocorticoid properties; this causes fluid

retention and hypertension resulting from sodium retention, water

retention, and hypervolemia. An increase in androgen levels causes

hirsutism. Altered fat metabolism causes a peculiar deposition of fat

characterized by a protruding abdomen; subclavicular fat pads or

“buffalo hump” on the back; and a round, plethoric “moon face.”

56. When lecturing about heart attacks(myocardial infarctions),

the instructor will emphasize the client may present with: Select all

that apply.

A) Substernal chest pain

B) Neck pain

C) Umbilicus pain

D) Deep, right-sided abdominal pain

E) Pain that radiatesto the left arm

Ans: A, B, E

Feedback:

Referred pain is perceived at a site different from the location

of its point of origin but innervated by the same spinal segment. The

sites of referred pain are determined embryologically with the

development of visceral and somatic structures that share the same

site for entry of sensory information into the central nervous system

(CNS) and then move to more distant locations. Pain that originates in

the abdominal or thoracic viscera is diffuse and poorly localized and is

often perceived at a site far removed from the affected area. For

example, the pain associated with myocardial infarction commonly is

referred to the left arm, neck, and chest, which may delay diagnosis

and treatment of a potentially life-threatening condition.

chronic pain usually serves no useful function. To the contrary, it

imposes physiologic, psychological, interpersonal, and economic

stresses and may exhaust a person's resources. It is often associated

with loss of appetite, sleep disturbances, and depression, which

commonly is relieved once the pain is removed. Trouble urinating

(dysuria) is usually not associated with chronic pain syndrome (unless

this is a preexisting condition like BPH). A person's ability to drive is

not a priority question asked of a client with chronic pain.

58. A client with a diagnosis of lung cancer has developed bone

metastases resulting in severe and protracted pain. Which of the

following assessment components should the nurse prioritize when

assessing the client's pain?

A) The appearance of grimacing, guarding, or wincing

B) The presence of changes in vital signs that correspond to pain

C) The client'ssubjective report of the character and severity of

pain

D) The results of a detailed neurologic assessment

Ans: C

Feedback:

Although objective signs of pain may or may not be evident,

the priority component of any pain assessment is the client's selfreport.

59. Which of the following interventions would be considered a

nonpharmacologic method of pain control? Select all that apply.

A) Distraction by knitting

B) Guided imagery

C) Biofeedback

D) OTC acetaminophen

Ans: A, B, C

Feedback:

A number of nonpharmacologic methods of pain control are

used in pain management. These include cognitive–behavioral

interventions (e.g., relaxation, distraction, imagery, and biofeedback),

physical agents (e.g., heat and cold), electroanalgesia (transcutaneous

electrical nerve stimulation [TENS]), and acupuncture. Even though

acetaminophen is an over-the-counter pain medication, it is still a

pharmacologic intervention.

60. A hospital client has been reluctant to accept morphine

sulfate despite visible signs of pain. Upon questioning, the client

reveals that he is afraid of becoming addicted to the drug. How can a

member of the care team best respond to the client's concern?

A) “You might become addicted, but there are excellent

resources available in the hospitalto deal with that development.”

B) “You should likely prioritize the control of your pain over any

fears of addiction that you have.”

C) “If you start needing higher dosesto control your pain, then

we'll address those concerns.”

D) “There's only a minute chance that you will become addicted

to these painkillers.”

Ans: D

Feedback:

Although long-term treatment with opioids can result in

opioid tolerance (i.e., increasingly greater drug dosages being needed

to achieve the same effect) and physical dependence, this should not

be confused with addiction. Long-term drug-seeking behavior israre in

persons who are treated with opioids only during the time that they

require pain relief.

61. Which of the following pathophysiologic processes occursin

cases of bacterial meningitis?

A) Infection in the cerebrospinal fluid causes vasoconstriction

and cerebral hypoxia.

B) Trauma introducesskin-borne pathogensto the

cerebrospinal fluid.

C) Infection in the cerebrospinal fluid causesspinal cord

compression and neurologic deficits.

D) Inflammation allows pathogens to crossinto the

cerebrospinal fluid.

Ans: D

Feedback:

In the pathophysiologic process of bacterial meningitis, the

bacterial organisms replicate and undergo lysis in the CSF, releasing

endotoxins or cell wall fragments. These substances initiate the release

of inflammatory mediators, which set off a complex sequence of

events permitting pathogens, neutrophils, and albumin to move across

the capillary wall into the CSF. Cerebral hypoxia does not result directly

from meningitis, and the causative pathogens are not introduced from

the skin nor is trauma an initiating event. Spinal cord compression is

not an expected consequence of meningitis.

62. Common manifestations of acute meningococcal meningitis,

a highly contagious and lethal form of meningitis, include:

A) Diplopia

B) Petechiae

C) Papilledema

D) Focal paralysis

Ans: B

Feedback:

Meningococcal meningitis causes a petechial rash with

palpable purpura in most people. The most common manifestations of

acute bacterial meningitis are fever and chills; headache; stiff neck

(nuchal rigidity) and back; abdominal and extremity pains; and nausea

and vomiting. Other signs include seizures, cranial nerve damage

(especially the eighth nerve, with resulting deafness), and focal

cerebral signs. General signs and symptoms of brain tumor include

headache, papilledema, nausea, vomiting, mental changes, visual

disturbances(e.g., diplopia), alterations in sensory and motor function,

and seizures. Like meningitis, encephalitis is characterized by fever,

headache, and nuchal rigidity, but more often clients also experience

neurologic disturbances, such as focal paralysis, lethargy,

disorientation, seizures, delirium, and coma.

63. A family brings a client to the emergency department with

increasing lethargy and disorientation. They think the client had a

seizure on the drive over to the hospital. The client has been sick with

a “cold virus” for the last few days. On admission, the clients'

temperature is 102°F. Which other clinical manifestations may lead to

the diagnosis of encephalitis?

A) Petechia over entire body

B) BP 100/72

C) Impaired neck flexion resulting from muscle spasm

D) Appearance of red-purple discolorations on the skin that do

not blanch on applying pressure

Ans: C

Feedback:

Like meningitis, encephalitis is characterized by fever,

headache, and nuchal rigidity (impaired neck flexion resulting from

muscle spasm), but more often clients also experience neurologic

disturbances,such aslethargy, disorientation,seizures, focal paralysis,

delirium, and coma. Meningococcal meningitis is characterized by a

petechial (petite hemorrhagic spots) rash with palpable purpura (red-

purple discolorations on the skin that do not blanch on applying

pressure) in most people. This BP is within normal range.

64. Which of the following individuals has the highest chance of

having a medulloblastoma?

A) An 88-year-old man who has begun displaying signs and

symptoms of increased ICP

B) A 60-year-old woman who issoon to begin radiation therapy

for the treatment of breast cancer

C) A 4-year-old child who has become uncoordinated in recent

months

D) A 68-year-old man who is a smoker and has a family history

of cancer

Ans: C

Feedback:

Tumors of neuronal origin (e.g., medulloblastoma) usually

occur during infancy and childhood. This is due to the fact that a cell

must be capable ofreplication to undergo neoplastic transformation.

65. Following surgery for a large malignant brain tumor, the

nurse should anticipate discussing which further treatment option with

the family that may ensure that any remaining cancer cells will be

killed?

A) Chemotherapy

B) Immunotherapy

C) Gamma knife radiation

D) Stem cell transplant

Ans: C

Feedback:

Most malignant brain tumorsrespond to external irradiation.

Irradiation can increase longevity and sometimes can allay symptoms

when tumors recur. The treatment dose depends on the tumor's

histologic type, responsiveness to radiation, and anatomic site and on

the level of tolerance of the surrounding tissue. A newer technique

called gamma knife combines stereotactic localization of the tumor

with radiosurgery, allowing delivery of high-dose radiation to deep

tumors while sparing the surrounding brain.

66. Which of the following clients is at greatest risk for

developing balanitis xerotica obliterans?

A) A homosexual male with a monogamous partner

B) A client who has had their pituitary gland removed due to

cancer

C) A male who has an uncircumcised penis

D) A middle-aged male with history of chronic prostatitis

Ans: C

Feedback:

Balanitis xerotica obliterans is a chronic,sclerosing, atrophic

process of the glans penis that occurssolely in uncircumcised men. As

such, the uncircumcised state supersedes the influence of sexual

behavior, prostatitis, or hormonal effects of not having a pituitary

gland.

67. Which of the following clinical manifestations are

characteristic for clients with Peyronie disease? Select allthat apply.

A) Painful erection

B) Thick, yellow discharge from the penis

C) Presence of a hard mass on the tunica albuginea of the penis

D) Papillary lesions on penis filled with serous-colored fluid

E) Thick, nonretractable foreskin of uncircumcised male

Ans: A, C

Feedback:

Peyronie disease involves a localized and progressive fibrosis

of unknown origin that affects the tunica albuginea (i.e., the tough,

fibroussheath thatsurrounds the corpora cavernosa) of the penis. The

manifestations of Peyronie disease include painful erection, bent

erection, and the presence of a hard mass at the site of fibrosis.

Approximately two thirds of men complain of pain as a symptom.

Discharge and lesionsfrom the penisis usually caused from infections

or STDs. Thick, nonretractable foreskin of uncircumcised male is

associated with balanitis xe

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